江苏省HIV-1基因型抗病毒治疗失败患者耐药检测结果分析

目的了解江苏省2010—2014年HIV-1感染者抗病毒失败人群的HIV-1耐药情况,为临床抗病毒治疗提供参考。方法根据耐药检测实验室网络收集江苏省2010—2014年的HIV-1基因型耐药检测结果,对各年度相关药物耐药情况、耐药基因位点及病毒基因亚型进行统计分析。结果 2010—2014年分别纳入样本74、113、197、278、346份,其中检测出现耐药结果的比率分别为68.92%、48.67%、51.27%、52.52%和57.80%。各年度间HIV-1主要耐药药物类似,核苷类主要有3TC、ABC、DDI和FTC,非核苷类药物以EFV和NVP为主。HIV-1对蛋白酶类药物耐药差别较大,且目前使用的LPV/r的耐药率在1%以下。年度间HIV-1主要耐药位点为184、181、190及103位,其中184位突变主要引起3TC和FTC耐药,而181、190、103位突变与EFV和NVP耐药相关。HIV-1病毒基因亚型均以CRF01_AE为主,且呈上升趋势。结论江苏省HIV感染者抗病毒治疗失败人群HIV-1基因型耐药率有上升趋势,应加强对抗病毒治疗患者的耐药检测,从而及时合理调整抗病毒治疗方案。

Drug resistance detection result of HIV 1 patients who failed in antiviral therapy in Jiangsu Province

ObjectiveTo investigate drug resistance of HIV 1 infected people who failed in antiviral therapy in Jiangsu Province from 2010 to 2014, and provide reference for clinical antiviral therapy.MethodsBased on the network of drug resistance detection laboratories, detection results of HIV 1 genotype resistance in Jiangsu Province from 2010 to 2014 were collected, drug resistance, drug resistance gene loci and virus gene subtypes in different years were statistically analyzed.ResultsFrom 2010 to 2014, 74, 113, 197, 278, and 346 specimens were inclu ded, rates of specimens with resistance detection results were 68.92%, 48.67%, 51.27%, 52.52%, and 57.80% respectively. The main HIV 1 resistant drugs were similar in each year, nucleoside drugs were mainly lamivudine(3TC), abacavir(ABC), didanosine(DDI), and emtricitabine(FTC), non nucleoside drugs were mainly efavirenz(EFV) and nevirapine(NVP). Drug resistance of HIV 1 to protease drugs was quite different, resistance rate of currently used lopinavir/ritonavir(LPV/r) was less than 1%. The major drug resistance loci of HIV 1 in four years were 184, 181, 190, and 103 respectively, 184 mutation mainly caused 3TC and FTC resistance, while 181, 190, and 103 mutation were associated with EFV and NVP resistance. HIV 1 gene subtype was mainly CRF01_AE, which showed an upward trend.ConclusionThere is an increasing trend of resistance rate of HIV 1 genotype in HIV infected patients who failed in antiviral therapy in Jiangsu Province, drug resistance detection for patients receiving antiviral therapy should be strengthened, so as to adjust antiviral treatment scheme in time.